Abstract: Objective To analyze the risk factors of esophageal variceal bleeding (EGVB) complicated with chronic hepatitis B (CHB) cirrhosis, and to provide reference for primary prevention and intervention treatment.Methods A total of 274 CHB cirrhosis patients with esophageal and gastric varices (EGV) admitted to the People’s Hospital of Hai’an City from January 2021 to December 2023 were involved in the study. According to whether EGVB occurred during admission or hospitalization, the subjects were divided into EGVB group (n=55) and non-EGVB group (n=219). Baseline data, serological and imaging indicators were collected. Univariate and multivariate logistic analysis were conducted to analyze the influencing factors and independent risk factors of EGVB in patients with CHB cirrhosis and EGV. The predictive value of each independent influencing factor was analyzed by receiver operating curve (ROC).Results EGVB occurred in 55 of 274 CHB cirrhosis patients with EGV (20.07%). The duration of cirrhosis, history of accidental trauma, history of portal vein thrombosis (PVT), hypersensitivity C-reactive protein (hs-CRP), positive red sign, portal vein diameter (PVD), liver hardness value (LSM), Child-Pugh grade C and model of end-stage liver disease (MELD) scores in EGVB group were 14.35±4.38 years, 16.36%, 23.64%, 11.07 mg/L, 83.64%, 17.52±2.48 mm, 20.47±3.65 kPa, 47.27% and 19.58±2.46 min respectively. They were higher than that in the non-EGVB group (12.46±4.15 years, 5.02%, 8.68%, 9.16 mg/L、31.51%、14.35±2.07 mm, 15.39±2.84 kPa, 19.63% and 16.28±2.4 min). The non-selective β-blocker (NSBB) treatment history and portal blood flow peak (PPV) in EGVB group were 29.10% and 0.13 m/s, which were lower than those in non-EGVB group (19.63% and 0.17 m/s). The above differential analyses all have statistical differences (t/χ²= 5,263, 3.482, 3.618, 5.068, 6.127, 7.629, 7.314, 4.576, 7.136, 3.482, 4.359, all P<0.05). Logistics regression analysis showed that positive red sign, elevated PVD and LSM, and Child-Pugh grade C were independent risk factors for EGVB in patients with CHB cirrhosis (95%CI 3.126-9.483, 3.457-11.296, 2.653-7.527, 1.735-6.428, 95%CI 3.126-9.483, 3.457-11.296, 2.653-7.527, 1.735-6.428). OR=4.715, 5.283, 4.129, 3.176, all P<0.05); Treatment history of NSBBs was a protective factor (95%CI 1.275-5.013, OR=2.461, P<0.05). ROC analysis showed that the area under the curve (AUC) of NSBB treatment history, positive red sign, elevated PVD and LSM, and Child-Pugh grade C were 0.702, 0.784, 0.827, 0.851 and 0.735, respectively. The sensitivity was 72.72%, 81.82%, 87.27%, 74.55%, 83.64%, and the specificity was 70.91%, 89.09%, 83.64%, 80.00%, 78.18% (all P<0.01).Conclusion NSBB treatment history, positive red sign, elevated PVD and LSM, and Child-Pugh grade C are the influencing factors for EGVB in patients with CHB cirrhosis.

Key words: Chronic hepatitis B, Liver cirrhosis, EGVB, Risk factors, Preventive measure